Dr. Gabrielle Lyon 7:04
Dr Christle, welcome to the show.

Dr. Christle Guevarra 7:07
Thank you so much for having me now. You are a family physician, and you also trained in sports medicine. You are educating a lot on the use of GLP ones, which we are going to talk all about that we’re going to talk all about fat loss, and you’re very interested in muscle preservation as well as performance.

Dr. Christle Guevarra 7:25
Correct? That is correct.

Dr. Gabrielle Lyon 7:27
Take me through what you are seeing right now in the landscape in fat loss and

Dr. Christle Guevarra 7:35
GLP one use, it seems like there’s a lot of good things happening, and there’s a lot of things that I’m like, ooh, we could do a little bit better. There’s a lot more emphasis on resistance training across the board, which is, you know, obviously I that’s always awesome. And so women, I’m seeing a lot more women in the gym physically. So that is also amazing. And a lot more patients are just receptive to the fact of like, oh, I don’t want, you know, this ozempic butt, so I’m going to get into the gym and lift something and challenge myself the you know, I feel like there’s still a lot of a disconnect where, you know, especially especially with the way medicine traditionally, is set up with clinic with checkups once every four weeks, three months. I think sometimes it can get a little hard to help with the behavior change aspect of the GLP one use and and so I find that there are still a lot of people who are struggling with, how do I eat, how do I exercise? I just take this shot, and I kind of, you know, I have these side effects, and I’m going to wait, you know, X amount of weeks till my next follow up appointment to bring them up. And so the medical system in which, you know, we’re kind of in the traditional practice model, just doesn’t seem like it seems like we could do a little bit better in providing that support when it comes to the behavioral change part.

Dr. Gabrielle Lyon 9:09
And you’ve actually been really public on your Instagram social media, talking about your own journey with GLP, one news, do you think that obesity five years from now, not even 10? Do you think we’re still going to be struggling with obesity? I think

Dr. Christle Guevarra 9:23
we’re going to be struggling with it a lot less so I think there are still going to be people who are hesitant to take these medications, just because of whatever you know this, it still feels like too good to be true, because we have a long standing history of diet medications that have not been so healthy for us, and, you know, have been recalled by the FDA back in the day, the rainbow pills in the 1960s 50s and 60s. So, you know, people still have that hesitation towards, you know, drugs that are, you know, FDA approved and. And people you know will still hesitate, but I think overall, population wise, I think that obesity is going to decrease.

Dr. Gabrielle Lyon 10:10
And again, you train in sports medicine, family medicine, you are on the front lines. There has never been something more effective than these

Dr. Christle Guevarra 10:20
medications, correct? This is a new this is, you know, a new breakthrough, and it’s only going to get better, especially with the drugs that are still in clinical trials and they’re coming down the pipeline. But, you know, after semaglutide, ozempic wegovy came, you know, became FDA approved for chronic weight management. It’s just been, you know, it’s just only going to go up from here. And I

Dr. Gabrielle Lyon 10:48
think that brings us how many generations are we in now? So that we’re in, is this Now

Dr. Christle Guevarra 10:52
we’re entering the third generation? I think so.

Dr. Gabrielle Lyon 10:56
Read a true tide. Read a true tide. Yeah. And that’s in phase three trials. Correct? What I understand? Correct. The GLP ones have been around for a long time, but they haven’t been used. They have not been FDA approved for weight loss. They but for a while, but they were used for diabetes. What was the what was it FDA approved for? It was for diabetes, right?

Dr. Christle Guevarra 11:23
Originally, it was for type two diabetes, and that was in 2005 with biota, and that was a twice a day injection the and if you take a look back, they were noticing some changes in weight loss, but it was somewhere along the order of five pounds in the error. If you look at actually, look at the graph in the in the paper, the error bars are just all over the place. And it was not nothing spectacular. And I think it was sex send a that was in 2014 That’s right. But again, the weight loss aspect was also still not that impressive, and you had to inject every day.

Dr. Gabrielle Lyon 11:57
So we used sex under in our practice. When that came out, it was, again, it was the best that was available, but it was not. It was nothing like the

Dr. Christle Guevarra 12:06
GLP ones. Every single time I tried to get that approved, insurance just denied it. So I just stopped. Eventually trying at least,

Dr. Gabrielle Lyon 12:18
and you’ve been someone who’s been fit and training. Have you been fit in training your whole life?

Dr. Christle Guevarra 12:22
I’ve had some periods where I was not so, not so mindful of my diet and exercise and but overall, over the course of what the last 40 something years, yeah, I’ve always at love sports. I was always very competitive. So you know, whether it’s in the classroom or in sports. So I’ve always been active. For the most

Dr. Gabrielle Lyon 12:42
part, you were doing competitive power lifting. Competitive power lifting. How was that?

Dr. Christle Guevarra 12:50
It was it was good. It was a It gave me a chance to start lifting weights. And throughout various parts of my life, adult life, I felt like, Okay, since I can’t figure out this whole Calories, Fat Loss thing down, I am just going to focus on lifting weights. And, you know, I get my confidence or find, you know, joy in taking, you know, taking ownership of the fact that I can lift something heavy, I’m competitive. I’m okay at this, and I’m having a really good time with meeting all these people, you know, at these different meets, and training, posting my training online, on these forums, and meeting people. So it gave me a lot of community, and it gave me a lot of confidence that I couldn’t get from, you know, hunger, fat, loss, you know, losing weight, you know, because I couldn’t get that part of the equation down. So I’m just going to focus on this for a really

Dr. Gabrielle Lyon 13:49
long time. As a fellowship trained physician, it was hard for you to get your macros and your nutrition under wraps.

Dr. Christle Guevarra 13:59
It was the calories. It was really nice.

Dr. Gabrielle Lyon 14:01
Yes, compared to you who are so highly trained and you’re doing a fellowship for you, it was difficult. I can only imagine what someone who didn’t have your education, the resources, how difficult it’s been for people.

Dr. Christle Guevarra 14:17
Yeah, I almost felt like even more guilty about it, because, yes, you are. I am, you know, I’m in medical school. I’m doing all these things. I’m taking care of patients. This seems really easy. Why can’t I do it? Like, what is wrong with me? So I took it, I literally for decades, took it as, like, this moral failure on my part, like I’m just not trying hard enough. I must be doing something wrong, and maybe if I do this XYZ thing, you know, maybe this will help. But I’ve dieted myself to to the point where I failed medical school anatomy the first time, and I had to retake it in back in the early Okay.

Dr. Gabrielle Lyon 14:57
Wait, tell me more. Tell me more.

Dr. Christle Guevarra 14:58
Oh, gosh, I. I was working with a coach who, you know, gave me my my meal plan instead of macros. And it kind of was around 1100 calories, 545, minute sessions of

Unknown 15:14
cardio a day. Wait How many? Five, five a day

Dr. Christle Guevarra 15:19
or No, five, five a week. Okay, five

Dr. Gabrielle Lyon 15:21
a week. I was like, there is no excuse that would be impossible for anyone

Dr. Christle Guevarra 15:26
lifting four times four, four times a week, and and then, yeah, eating this X amount of calories. And some days there were no no carbs, so it was just protein and fat. And I, you know, I felt like garbage. I did not and I had entered medical school summer anatomy. It was the and of course it was summer anatomy for all of the overachievers who wanted to take it first, and then in the fall, when the rest of the med students come in, you can be a TA and you can put it on your resume and get paid. And of course, I was going to do it. I couldn’t sleep because the hunger pangs were so intense. I could hear my stomach growling. And then I would come into anatomy lab, just a zombie trying to figure out what muscle is what and I’m just like, I don’t know, because I’m exhausted, and, you know, my neurons are just arguing over the last calorie, and so, yeah, I failed by a couple percentage points. And I just remember feeling like, Wow, I can’t die. I’m nowhere, even close to being lean. My, you know, lifts are all in the tank, and I just felt like I had to will power my way through it, and I failed anatomy like, this is like the worst way to start off my medical training. And so, yeah, I learned a whole lot of things from that experience. But for somebody to say that, Oh, you just didn’t try hard enough, I just want to be like, let me tell you, we tried. We really tried.

Dr. Gabrielle Lyon 17:00
It’s interesting, though, because we are seeing two sides of the story. And what do I mean by that? People will say, the people that don’t use GLP ones are saying, Okay, well, if you use it, you’re cheating. And as someone who was struggling with it and who tried? I mean, is that your perspective?

Dr. Christle Guevarra 17:25
Oh, gosh, no. I think it’s it’s an amazing tool to you. We have in the toolbox, and it has allowed, not just for myself, to thrive so many other people couldn’t find they just were struggling to even get out of bed and get to the gym, and found that, you know, some days, like, after starting this medication, yeah, their their weight started to go down, but they also found the motivation to make it to the gym and start doing the things that everybody’s telling them to do, like, you need to eat less, you need to move more. Well, some people are still so stuck in a loop of, you know, dysregulated hunger, feeling depressed, depressed and guilty, because why can’t I just do this thing? And here is this medication that shuts off that food noise that persistent, like drive to think about food, that they can actually focus on the tasks that they need to do. Their quality of life just goes up and goes up from there, and

Dr. Gabrielle Lyon 18:23
it’s amazing. And the other part that I think that we’re seeing online is, who gets it, who deserves, for lack of a better term, to be able to utilize it? Yeah, and

Dr. Christle Guevarra 18:39
you know, I’m so glad we’re having this conversation now, and not what four years ago, when the shortages were, you know, apparent. And so you had people with type two diabetes, you had people with obesity, kind of fighting over, like, who really deserves it? The, you know, the technical FDA cut off is over BMI over 30, you know, and then BMI over 27 plus, you know, some comorbidity like high blood pressure, high cholesterol, syndrome, x, right? And sure, like, that makes sense. There is a little bit of wiggle room. Because, I think a very common question I get asked is, like, what about, you know, somebody with a BMI of 26 or, you know, because it’s overweight, but it’s not in, you know, normal BMI calorie who might be struggling? I think there is some gray room. And, you know, in medicine, there’s, you know, there’s the there’s an art to it. So you have to think about somebody’s diet history, and then, why did they fail? Why did they struggle? And, you know, are they having persistent food, you know, thoughts about food, like, what happens, you know, 10 weeks down the line, or 12 weeks during a diet? Like, do you, you know, do you just stop working out? Do you, you know, are you binge eating or whatnot? Like, you have to ask these detailed questions about why it is, you know, why did these other things not work? And so you know, it’s not just a numbers game whatsoever. I mean,

Dr. Gabrielle Lyon 20:05
totally agree with you. We also know that BMI doesn’t tell us anything about the body composition. For those of you listening, you all know what BMI is, body mass index. It’s really used, or had been traditionally used for insurance, to determine outcomes, potentially, but it doesn’t say anything about your body fat percentage and your percentage of muscle mass, both of which are much more relevant when it comes to assessing health outcomes. And then the other thing is, as physicians, who is it to say? For us to say if a patient wants to try something, yeah, and they might not meet the criteria from our perspective or from a BMI number or even a body fat percentage. And I’m not saying that their body fat percentage is 18% but let’s say they have struggled with the same five to 10 pounds, and it is causing them so much grief, and it is consuming them, yeah. How is that for us to say, well, continue for another five years to try x, y and z, but this person who is 20 pounds overweight, they deserve to have it exactly,

Dr. Christle Guevarra 21:20
and that’s the part that’s and I’ve, I’ve had somebody asked me that before, and I didn’t have a really good answer, and I was like, That is actually a really good point, because we don’t, it’s not like, Oh, you’re, you know, a 1c is, you know, 6.5 therefore You definitely deserve, I think there is a gray room, because there’s a lot of people, a lot of The things that I have picked up from the fitness space of, you know, make sure you get tons of fiber. Make sure you eat lean protein. Well, when somebody’s eating, you know, like a whole bag of frozen strawberries and like a whole bag of frozen broccoli, to get in as much fiber, to feel satiated. And they still don’t, and they’re still trying to pretend like this food, like they’re not persistently thinking about food, I have to wonder, is that person, would that person benefit from a GLP one versus trying to employ all these other

Dr. Gabrielle Lyon 22:14
So, and I don’t know, so if it were me, I would say yes, they would, even if it’s not to the full dosing, right? There’s ways in which we use medications off label all the time. And then we’re starting, I’m sure you’re starting to see the data emerge that is helping with addiction, with alcohol usage.

Dr. Christle Guevarra 22:36
Yeah, anecdotally, and yes, I have started to see that anecdotally, I find that people are just not really wanting to drink, or if they do, it’s a lot less than what they used to consume. And it’s hard to say whether or not that comes with the also all the other behavioral changes or not, at least in my patients, because that it’s, it’s all, all in one. I can’t separate the two. Cigarette smoking. Anecdotally, seeing a lot of people who are like, I don’t really want that

Dr. Gabrielle Lyon 23:09
as well. I mean, it’s pretty extraordinary. Again. Think about we are alive at a time that the landscape of medicine is changing. When I was doing my fellowship in Nutritional Sciences, the big thing was bariatric surgery. Oh, gosh, they were doing bariatric surgery because these medications, so part of the job as a fellow, I’m sure you probably had to work games and yeah, what was so you guys listening in fellowship, each fellow is responsible for it’s typically a clinic within that specialty, and for nutritional sciences, because I did a combined Nutritional Sciences geriatric fellowship for the nutrition part, I had to run. I got to it was actually amazing run a weight management clinic. Oh, it was a weight management clinic, and this was 2015 GLP ones were not approved for weight management. Oh, boy. These people struggled so much that many of them would end up doing bariatric surgery. The outcomes for bariatric surgery, whether it was banned, ruin, why they’re not good? Yeah. I mean, the immediate weight loss is impactful, but the secondary complications with gastric emptying, with nutritional deficiencies, it seems as if a lot of people end up reverting back. These medications were not FDA approved or used. Geez. Now we’re in an entirely new landscape that is taking away. I mean, if someone were to choose bariatric surgery or GLP one, I mean, this is a new landscape now, yeah,

Dr. Christle Guevarra 24:50
the approval process, the surgery, like surgery itself, is a risk factor, and especially for somebody who is obese, the anesthesia. Yeah, you know, having to intubate them to get surgery, all of that has complications. And so, yeah, I would, I would honestly have them recommend, you know, let’s see what all these medications can do first, and then if all of that fails, which I, you know, I haven’t come across a patient yet where medication has complete like we have a couple of different choices, other than GLP ones, where we need to start thinking about surgery, something a little bit more extreme. Do you

Dr. Gabrielle Lyon 25:30
think that meaning they failed? GLP ones? Correct that. How often do you see that?

Dr. Christle Guevarra 25:37
I don’t see that quite often, what I the more typical scenario that I do see is insurance, you know, comes in and says, we’re not covering this, or we’re only covering this partially, or your insurance has changed. Congratulations. So let’s figure that out.

Dr. Gabrielle Lyon 25:56
Are your patients maintaining the use of GPU and so some of the recent data that I’ve been seeing is that the typical person will stay on a GLP one for two years, and the 78% come off after two years.

Dr. Christle Guevarra 26:12
So the I don’t have not every I have seen, some of my patients come off of it, mostly because of insurance reasons, and they are still able to maintain it’s, it is definitely a lot more, a bit more of a challenge than when they were on it. But they, you know, the behavioral change part, the lifestyle part, is so important, and having that support system is also, I think, is pretty much key, you know, key to maintaining that and keeping regular follow ups so and I’ve seen other other people who’ve shared their stories with me online, where they’ve come off of it because they wanted to, and are still thriving and still doing great. So it’s not like you are doomed for life, but for some people, you know, even for myself, I probably will be on it for life, and I’m okay with that. It’s not a moral failure,

Dr. Gabrielle Lyon 27:04
because it’s improved your quality of life so much. Yes, gosh,

Dr. Christle Guevarra 27:09
it’s not. And it’s not just the physical aspect of it. It’s it’s a lot of people, when they describe the like, the first time you start on the medication, it’s like this light bulb went off in my head, and everything just went quiet, and now I’m able to have a conversation with you. Like, if we would have had a conversation five or six years ago, I wouldn’t be able to pay attention to because I would be thinking, Gosh, I’m so hungry right now. The lights are so bright, but, like, I don’t I’m really embarrassed. I don’t want to admit that. You know, I have a problem thinking about food all the time, and it would just be like this spiral of despair going on my head, and I would just smile and nod and be like, everything’s okay and everything’s not okay. And so it’s really given me the space to think about how I want to show up in this world, how I want to live my life. Who am I talking to? How am I talking to you? And just really gave me a chance to do a lot of self reflection.

Dr. Gabrielle Lyon 28:08
Is that why you were able to be more public about it, as opposed to not necessarily share your story?

Dr. Christle Guevarra 28:15
I think it was a combination of that and just being in my 40s and, you know, perimenopausal. I think there’s also that shift too, where it’s like, I just don’t care, like, you just stop caring what other people think. And I think about all the struggles that I’ve gone through trying to lose weight over the course of decades, and if I can help one person, you know, not feel so alone in, you know, in all of this, like I feel like that it was worth it. It was worth whatever it is the, you know, Internet has to throw at me,

Dr. Gabrielle Lyon 28:51
hopefully good things. And also at this point, it’s if it’s good, if it’s bad, it’s this is the new world that we live in. But one of the things that I really respect about you is that you are a trained physician. Now, it’s also what we’re seeing in research that there’s a lot of filler information. They’re using AI to create data. I mean, it’s not the creation of new data, but think about it, when you and I were in school, oh gosh, it would take a long time to get something published the quality of the research, but now what we see is that AI, people are using AI, and they’re filling up the space. Why do I say this? Because people don’t know where to go for good information anymore. Someone could have a doctor in front of their name, and it might be deeply misleading. Maybe they’re, I don’t know, a doctor of botany or something, and there is something to be said for a trained medical provider that has studied, you know, general health, family medicine, sport. Medicine to be able to make informed decisions.

Dr. Christle Guevarra 30:02
Yeah, I definitely think that there is something to be said about having that face time in the clinical hours. Because if there’s one thing that I took from Family Medicine, my and sports medicine training is there is just this deep, intuitive sense that you don’t get until you get, you know, face to face time, and the times where I have nailed a zebra diagnosis, or, you know, some like life or death situation is not because I had the answer, like I memorized the book, or I read some, you know, study on PubMed, it’s because I looked at that person, I was listening to them, and it was like something just seems really off, and I’m not sure why. So let’s get this ultrasound, let’s get this MRI, and let’s go from there. And you know, sure enough, you know, somebody athlete with a leg clot, a blood clot, or something like that, and it’s just something just is telling me that like this. You know, this isn’t normal.

Dr. Gabrielle Lyon 31:01
Unconscious competence, yeah, the unconscious competence you mentioned. Perimenopause, yes. How has that changed your perspective on hormones, for yourself, for your patients?

Dr. Christle Guevarra 31:12
Oh my gosh. So that was definitely an experience that has really got me thinking about, you know, all the other physicians in the forefront of hormone menopausal hormone therapy, just because I had no idea, it sort of blindsided me, and I was like, What is going On? All of these symptoms

Dr. Gabrielle Lyon 31:37
were some of them.

Dr. Christle Guevarra 31:42
It at first it started off really just sort of, I didn’t I wasn’t feeling like myself. It just the word forgetfulness, and it was very similar to the word forgetfulness I had when I took, when I was prescribed medication off label for weight management, Topamax is

Dr. Gabrielle Lyon 32:02
that limit? That’s Lamictal, right? No, I know no. Topamax is no

Dr. Christle Guevarra 32:08
toparame to pyramid, yeah, very similar to that. And I was like, I’m not on that medication. Anxiety, that worsening anxiety, I would wake up and just feel like the world is coming to an end. That’s called parenthood.

Dr. Gabrielle Lyon 32:23
That’s called 5.5 in the morning,

Dr. Christle Guevarra 32:27
insomnia, the hot flashes, and then I would get this awful like neck rash on top of it, eczema in my eye that just never appeared. And then finally, the genital urinary symptoms. Was like the last straw. That was when the workup for the thyroid, the heart, all of it came back normal. And at the time, my provider said, you know, everything’s normal, and there’s nothing I can do for you. Those were the last words. And I just remember thinking, oh gosh. Well, I still have all of these symptoms and all of this other stuff is normal. So we’re not going to do anything like and I think, as a provider, especially as somebody who is a primary care provider, the you know, if some everything came back normal, sort of, my response would be like, let’s figure something else, absolutely, let’s, let me send you to a specialist, absolutely, to, you know, if I don’t know if it’s this, let’s, you know, send you to a specialist. And so I really, I thought about that, and then I remember, gosh, I can’t remember if it was Rachel Rubin’s big podcast, talking about this and thinking about it in terms of, you know, sending grandma to the hospital with urosepsis, and I just thought of all the admissions that I had to do as a resident, you know, grandma with, you know, altered mental status from a UTI, and thinking about, how many times could I have prevented that? That’s I think that for me, was the kicker. And I was like, I need to get I need to get my CME up. I need to start really like, hey, we need to just be vigilant and thinking about these things early, like late 30s, and just asking those questions, how are you feeling? And you know, if it’s not this, then we need to find other answers.

Dr. Gabrielle Lyon 34:16
But again, this is the changing landscape, because before the Women’s Health Initiative, from what I hear from the older providers, they were all prescribing hormones. Yeah, there wasn’t any reason why people weren’t, for the most part, it was very ubiquitous. And then, of course, the Women’s Health Initiative came out, and it seemed as if overnight, people stopped prescribing hormones.

Dr. Christle Guevarra 34:39
Yeah, I didn’t, I was not really a thing when I was being trained as a family medicine physician, and so now I’m like, I gotta catch up, which is great, because I think they put it in such a way that, like we are physicians, we have prescribed medication before. These are not, these are not scary medications.

Dr. Gabrielle Lyon 34:57
What do you tell your Are you prescribing hormones? Do you typically prescribe hormones?

Dr. Christle Guevarra 35:01
Currently no

Dr. Gabrielle Lyon 35:03
in terms of fat loss and weight loss? What is the rate for your your patients that come in and you’re like, Okay, we’re gonna go and we’re gonna try to lose X number of pounds in totality, or do you do it that way? Do they have a goal for if they’re going to lose 20 pounds, and how they’re going to

Dr. Christle Guevarra 35:22
do it. So I it really it does depend on what they’re starting, what we’re what we’re starting with, but I do tell them that, like, if the goal is 20 pounds, and that seems like a reasonable goal, we may not do it all in one shot. Because I also want to make sure that we are thinking about what happens after the diet. I also want to make sure that I’m not missing any kind of diet fatigue markers, like poor sleep, poor performance in the gym, you know, any of that stuff, because that can come crashing down depending on what their life situation is like. And so I don’t want them to feel like I have to burn I have to get this off, you know, now I want them to start thinking about this in terms of, this is going to be a lifetime thing. So it didn’t take you. It took you a long time to get to this point. Like there is no rush. I want a really good point.

Dr. Gabrielle Lyon 36:14
People feel as if they have to rush, get it done, do it right now, when the reality is, many people struggle for years, take a step back, going a little bit slower, reorienting ourselves to whatever the goal is, makes a ton of sense.

Dr. Christle Guevarra 36:31
Yeah, and I find that it’s a lot a lot more sustainable, you know, getting to the gym, lifting weights, meat, you know, cooking, meal prepping, cooking whatever it is, and figuring out, how is that going to look for you? How is that going to look for your family? How are they going to be involved in the process? How I’m

Dr. Gabrielle Lyon 36:48
Are you prescribing GLP ones? Okay, yeah, take me through your decision making process. Again, we understand that you’re not the listener, and maybe your patients are listening, but again, we’re not giving medical advice, here she is. But there’s got to be some decision making protocol that you go through in your mind, as opposed to Okay, a patient comes to you and is like, hey, I want to go on. GLP, one, yeah,

Dr. Christle Guevarra 37:15
tell me what. Tell me why, and tell me through. Take me through your you know, like diet history. Have you tried losing weight without a medication before? How has that been for you, and what are you currently doing right now? Take me through your day, because I find that that is a much better way of trying to get some information. Because I find that patients are very well intentioned. They really want us to, you know, to not judge them, because it’s a very sensitive talk, for sure. And so I get a lot of, you know, I just don’t understand. I’m eating chicken breast, you know, and I’m eating lean fish, and then, you know, for dinner, like, I don’t snack, and I’m like, okay, that’s really awesome. What was your last meal like before, you, you know, before we had this conversation. Take me through that, and then take me what happened? What did you do when you woke up? And so the conversation then becomes, you know, I’ll start thinking about, like, what are the major themes of, you know, why things didn’t work? Is it because, you know, oh, I had, you know, this life event that happened? Or am I having persistent thoughts about food, you know, at a certain point, or do you think, how often do you think about food? Is it like something that’s, you know, ongoing in your head? Like, how do you feel like, you know, it’s impacted your quality of life, your job, your relationships, and then, yeah, from there, just thinking about, like, you know, if that is the case, maybe we can start thinking, I think a medication would be very helpful.

Dr. Gabrielle Lyon 38:45
What are some of the biggest challenges that they come in and say that they’ve struggled with?

Dr. Christle Guevarra 38:52
I wouldn’t say, I would say this doesn’t come up as soon as they walk in. I think after a while, I start to see themes of I take care of everybody else, and I put myself on the back burner. And it’s not just with the kind of physical aspect part, but emotional they have seemed to be providing for everybody else, whether it’s financially, whether it’s relationships, whether it’s emotionally, and trying to find the words to kind of stand up for themselves and say, like, I’m not okay with this, or I’m not really comfortable with this conversation, or I don’t appreciate being spoken to like that. Those come out later, but you have to stack up these little wins for them to get the confidence to branch out and think about how is this relationship kind of affecting me, and is this now a net positive? Now that I start, I’m starting to take care of myself, and I really like myself, and I really like this new me, this new life, this new identity, right?

Dr. Gabrielle Lyon 39:53
It’s so transformative for people. And again, if you’re listening to this, we’re not saying that you have to use a GLP one, or you don’t have to you. Use a GLP one, but just as a very broad overview, it allows people to choose, as opposed to before, oftentimes and again, I ran a weight management clinic, they didn’t have a choice. And what do I say? They didn’t have a choice. It appeared that food was running their life no matter what they did, whether they tried Fen fan, whether they tried, you name it, it, they couldn’t get ahead. And so these medications now allow people to step into a new version of themselves, and then their lives change. So there’s two things that I seem to experience with the patients is that, on one hand, they are uncomfortable with their weight loss, or uncomfortable with just this new version, and they might sabotage themselves. That’s That’s one one group, and again, it’s not black or white. And then the other group is they really transform their lives, and their relationships, change their friend groups, change everything. It’s almost as if they’re on this rocket ship where now they get to make these choices. Yeah. So I just think it’s, it’s unbelievable. If I were to ask you, is it science? Is it hype? Where do you fall in the category of any part of that discussion?

Dr. Christle Guevarra 41:31
What the science versus

Dr. Gabrielle Lyon 41:33
hype in terms of GLP one? So you’ll hear, Oh, GLP one, medications. At any moment in time, you will hear about all the negatives. Yeah, right, oh yeah, you’re gonna get pancreatitis, thyroid cancer. It’s gonna stop your gastric emptying. Oh gosh. Okay, so tell me about some of the the actual risks versus the perceived risk.

Dr. Christle Guevarra 41:57
The pancreatitis thing is a very low absolute risk. And you know, anecdotally, I will say I have a colleague whose patient did end up going to hospital from pancreatitis and still managed to text going to the hospital for pancreatitis. GLP, one still worth it, so, which also, you know, but honestly, though, when we talk about quality of life, the person is still clearly having a very serious event and is still making that choice of like this is still a net benefit overall. So And who am I to argue with, with somebody who says that? But again, the risk is low. It’s serious, but when it happens, but it is very low, most commonly, nausea, vomiting, constipation, diarrhea are the most common symptoms, and those can be managed with expectations, with making sure to not crash diet, making sure to stay hydrated, and they tend to go away over time.

Dr. Gabrielle Lyon 42:56
How long does it take for some of the symptoms to reside

Dr. Christle Guevarra 43:01
for some people it can take, you know, weeks. For some people, it can take a few months. And I think it’s, I don’t have enough of a kind of, you know, general, enough of a kind of n to generalize, like, how often, but it can vary.

Dr. Gabrielle Lyon 43:21
Yeah, we see that in our our clinics, we have a telemedicine clinic. It’s called strong medical which because obviously, muscle is the most important organ. Although we’ve had urologist on the podcast, they think that it’s something else but muscle and fat regulation and the use of these GLP ones. This is, again, more of a conversation. Do you want to touch on the rate of muscle loss, or muscle loss with GLP one, medications and counterbalancing?

Dr. Christle Guevarra 43:53
You know, the rate of muscle loss with these GLP ones. I’m not too entirely familiar with the the exact numbers on it, honestly, with the as long as you are actually resistance training and keeping your protein intake reasonable, you can really avoid all of that. And you can actually, for somebody who’s relatively new to resistance training, can actually get some pretty decent recomposite, body recomposition in ways that I’m just like, actually sort of like, even more surprised to myself, because for somebody who’s never gone to the gym, I will give them something very easy to do, like three sets of 10 to start off with, and only because 10 is an easy number to count to, and watching them sort of progress from there, and as long as they’re consistent, you can get a whole lot out of it for a while before you have, you know, start thinking about like, let’s move on to like, a more, you know, advanced Protocol, or start thinking about all these other things, like, no you can just, we can just stay here for quite some time and milk the. Sort of newbie gains out before we need to start thinking about anything

Dr. Gabrielle Lyon 45:04
else, meaning in terms of adding more complexity, yeah, yeah.

Dr. Christle Guevarra 45:09
I really want to keep things consistent. Like, as long as I would rather have somebody go to the gym consistently than really start thinking about like, oh, do I need to be on this program, or do I need to be on that program? Yeah, we could talk about that. Let’s build up some, you know, consistency first, and then let’s think about, you know, something a bit more advanced.

Dr. Gabrielle Lyon 45:30
What was the biggest, or what has been some of the biggest surprising features in the use of GLP one in training?

Dr. Christle Guevarra 45:38
Gosh, just how, the way in which it calms down, sort of this persistent thoughts about food in a way that’s completely different from a stimulant like Fen, Fen or using caffeine, ephedra, ephedra, it just, it’s so different. It really is just like you, you know, there are times you have to be a lot more intentional about your nutrition, because you people can’t. And I’ve done this a couple of times where it’ll be 3pm and I’m like, oh, oh, why am I, why am I lighthead? Oh, I haven’t eaten. I should really think, you know, and I next day, I’m like, I really breakfast, breakfast, and make sure I eat that, and make sure it, you know, I fuel myself, so I don’t end up in this situation. But so many people have ended up in that sort of similar situation, where you have to think about your food consciously, versus, you know, before the medication, when you’ve got, you know, food is just taking up all that space in your brain.

Dr. Gabrielle Lyon 46:43
And that’s, again, that’s that’s been surprising for you, surprising for your patients, in terms of the protection of muscle mass. Yeah, the data doesn’t show that there’s something inherent to the GLP one that’s negatively affecting skeletal muscle mass. Honestly, if you look at some of the other bigger data sets, I think it improves muscle quality by decreasing this intramuscular adipose tissue, this intramuscular fat, again, you get that from training. But there’s something I think we’re going to begin to see more positive effects on muscle versus any kind of negative effects. Do you always talk about training with your patients and no, and or provide them with some kind of protocol?

Dr. Christle Guevarra 47:29
Yeah, I do. I it’s one of the very first things that is, like part of the kind of things that I

Dr. Gabrielle Lyon 47:36
tell me to Dr crystal, you get Jack,

Dr. Christle Guevarra 47:41
we’re gonna at least, we’re gonna at least do our best be always talking about how important resistance training is, and I think it’s also because a lot of people just have busy lives. So, you know, versus cardio, there’s nothing wrong with cardio.

Unknown 47:56
I love cardio. How much card are you doing?

Dr. Christle Guevarra 47:58
Am I doing? Personally, she’s like, none i Well, I do train jiu jitsu. I do a lot of NoGi because it is so it’s basically a gnocchi Nogi. So I don’t have the oh no Gi, yeah.

Dr. Gabrielle Lyon 48:14
So I thought, okay, got it. I heard gnocchi. And then I thought there was some other kind of training scenario, NoGi, okay, so it’s a

Dr. Christle Guevarra 48:25
little bit more faster paced, a lot of like wrestling takedowns, and so you do need to be in some, a lot more of a cardio shape to handle that kind of sport. So I do that twice a week, but one of the days is a two a day. And so I’d say 1234, about five hours of that

Dr. Gabrielle Lyon 48:47
a week. Amazing. And that’s what you use for cardio. I do when you are using a GLP one. And obviously your macro intake is probably much lower. Your total caloric intake is lower. Do you find? And you also work with the athletes as well. I do do you find that their performance decreases with GLP one use? I think

Dr. Christle Guevarra 49:09
it really depends on what their diet is looking what their diet is all about, because not everybody who’s on a GLP one is necessarily like trying to lose fat. There are times where people are on a GLP one and trying to maintain whatever their body weight is. And I find that, you know, if they’re in maintenance, they’re they do just fine. There are some very mild, mild trade offs when you are in a calorie deficit and trying to do a sport or, you know, or whatnot. But overall, it really depends on the calories and not necessarily like the drug itself.

Dr. Gabrielle Lyon 49:45
That’s an excellent point that it is not because we there is somewhat of a discussion that people seem to be either for or against, such as the way of the world nowadays, but it’s either they’re just really on board with jumpy ones or. Not and it’s the decrease in potential performance is not necessarily related to the drug, the mechanism of action, as to what this drug is doing to tendons or flexibility, or any of these other you know what you know, markers of fitness, or the requirements of fitness, but the decrease in in total calories. Who would you not recommend having these medications? I mean,

Dr. Christle Guevarra 50:27
somebody who I’m concerned with anorexia. But that seems pretty that seems obvious.

Unknown 50:32
I Yes, but

Dr. Christle Guevarra 50:35
also they’ll never be too obvious. It can never be too obvious. And the I’m trying to think of all of the concerns from the social media community about, you know what to look out for, for eating disorders. Thinking about somebody who is excessively exercising, somebody whose calories are already pretty low, that would make sense. That seems to make sense. I’m just really struggling to find, you know, maybe that population just hasn’t I haven’t come across too many people in that population group

Dr. Gabrielle Lyon 51:13
who we don’t actually get the those patients either. But then again, we much less likely to prescribe some yes kind of Yeah, going down that resistance training is a non negotiable. Correct? You, when you have patients on the GLP ones, what are the markers that you are seeing change the most, or that you’re looking to see change in terms of blood work,

Dr. Christle Guevarra 51:36
cholesterol, the the total cholesterol, LDL, typically goes down. I do see improvements in a 1c for you know, I do have some people who have, you know, who are. I prescribe it for weight management, but also they have diabetes. So I am seeing improvements in their blood sugar, their sugar logs overall, just with the resistance training alone, has been a huge help. And so I think that’s you know really about it. I don’t pay attention too much with the any labs beyond that, just because, whether it’s, in short, an insurance issue or whatnot, because I start have

Dr. Gabrielle Lyon 52:23
to thinking. I see, so you’re very strategic

Dr. Christle Guevarra 52:24
in terms of this is going to cost.

Dr. Gabrielle Lyon 52:27
I see the profile. We see changes in triglycerides, oh no. You see decrease in fasting blood sugar. We see changes in insulin. Sometimes we see lower levels of insulin, hemoglobin, a, 1c, what else you know? What else that we’re seeing? Anecdotally, a decrease in inflammatory markers, HS, CRP, some, sometimes decrease in sed rate. For you guys listening again, what we’re trying to do is provide somewhat of a balanced are we trying to provide a balance? I think we’re both in favor of GLP ones. I am, so maybe it’s a bit biased. But also, we’ve also worked, I mean, I’ve worked in weight management, obesity medicine for I don’t know. I started studying nutrition almost 20

Dr. Christle Guevarra 53:14
years ago, yeah, and I will admit I do have a bias because of my own experiences struggling with this. I am, you know, biased in the sense that I probably would lean more towards prescribing this medication than trying to gate keep just because of what I’ve experienced, both there and then also in the fitness space, trying to do all the lifestyle things which are important, non negotiable.

Dr. Gabrielle Lyon 53:40
The medication can quiet the noise that affects the brain. Decreases gastric emptying can improve insulin sensitivity. However, you can’t just go eat Cheetos and drink

Dr. Christle Guevarra 53:52
rip its Oh, gosh. Now I feel like people who’ve actually done that have ended up getting sick, and they were like, Okay, this is a learning lesson, sure, like, we need to start being way more intentional about our nutrition. And, you know, there are times where I’ve had to act more like, I feel more like a mom, a nagging mom, than I do a doctor, where it’s like, hey, let’s get some goddamn fiber in here. Let’s get a fruit, let’s get a vegetable in here. Like, how can

Dr. Gabrielle Lyon 54:19
we make this? Dr, blueberry is just she’s dropping the hammer. What is the minimum amount of protein that you recommend for your patients?

Dr. Christle Guevarra 54:26
So what is it? You know, the point eight to one gram per pound of ideal body weight, we say

Dr. Gabrielle Lyon 54:33
100 grams. Yeah, less than 100 grams.

Dr. Christle Guevarra 54:35
Yeah, I guess, I guess so that really does turn out to be such that and and then from there, I’ll try and figure out, like, what meals, or how do you actually cook your meals? And then trying to figure out, what can I swap in or give them, sort of, you know, here are some proteins to choose from. And let’s start there. How does this, you know, you know, go and sometimes they’ll text me from the grocery store, like, Hey, how’s. Look, and I’m like, patience,

Dr. Gabrielle Lyon 55:01
you better not be texting, because you just better not be doing I’m kidding, my patient. What about supplementation? Do you utilize supplementation, especially with the use of GLP ones, and if calories are down, total food consumption is

Dr. Christle Guevarra 55:19
down, you know the I think, especially at first, the overall food is down, because they’re thinking about the nausea and whatnot. Eventually the food, the food volume, does go up, the hunger sort of returns. I keep it very simple, especially for resistance training, I’ll have them, you know, try creatine.

Dr. Gabrielle Lyon 55:41
How many grams?

Dr. Christle Guevarra 55:43
Gosh, five.

Dr. Gabrielle Lyon 55:45
Five grams. My dad’s really big into creatine right now, we usually recommend between three and five for muscle and then 10 to 12 for brain health. Okay, okay. My dad’s like, I mean, listen, my dad is major placebo, and he does listen to this podcast. But anyway, what we’re seeing is that for cognitive function, also perimenopause, yeah, yeah. So creatine

Dr. Christle Guevarra 56:08
is one creatine is one multivitamin, just to make sure you’re covering your bases. And then from there, it really becomes what you know, what can you afford? What are you, you know, interested in, then becomes a conversation. Because I do find that I want to be very mindful of financial costs, as far as you know, risk, benefit, pros and cons. And have you always

Dr. Gabrielle Lyon 56:31
been like that with the patients

Dr. Christle Guevarra 56:33
I think I have, and I think my personally, just coming from a child, the child of immigrants, I just I’m always thinking that is always something that I’m thinking about, how can I, how can I make this work on a shoestring budget? So there are times in medical training where I’ve tried to shop, like, see how few dollars I can spend, whether it’s, you know, chicken breast versus chicken thighs, whether it’s oatmeal as a source of carbs, thinking about frozen fruit, because fresh can sometimes go bad, thinking about what is available like through SNAP, you know, EBT, which, by the way, what is

Dr. Gabrielle Lyon 57:15
going to be available is changing now. Yeah. What do you think about this new food guide, food guidelines?

Dr. Christle Guevarra 57:23
The I’m still really can’t get past the the destruction of my plate. I’m still very like, it was just very easy for me. And I

Dr. Gabrielle Lyon 57:33
mean, you could still use so in you could, you could you saw that forever strong.

Dr. Christle Guevarra 57:38
I know I did. And I was

Dr. Gabrielle Lyon 57:40
like, right? We kept the plate. You know, from our perspective, the you’re laughing, but we see patients, and so first of all, I love the new guidelines. And also, Don Layman and some of my colleagues wrote the guidelines. I am completely biased. However, all the science is available. Oh, good meaning, if you go to the website, you can see that where they chose the data is transparent. It’s not epidemiology. They only use randomized control trials. For you guys listening or watching this at home. Why that’s so important is because in the past, it’s always been epidemiology, which is low quality data, which should only be used to pose a hypothesis, not to make broad public generalizations and implications on public health. Yeah, so I’m very excited. I needed to cut you off there. But no, no. Tell you about how much I love these

Dr. Christle Guevarra 58:34
dietary guidelines. The dietary guidelines are great. I just, I just are upset about the plate. I am very upset. I think I’m way, way too more upset than I need to be. And it’s just I have so much emotion. It’s just I couldn’t, I was like, staring at the screen, like, where is where’s the cut off with the lean meat and the oil,

Dr. Gabrielle Lyon 58:53
and I just couldn’t say that is it? Can we touch on that? Because that is, do you want to? I would share what your perspective is on that. And I will definitely

Dr. Christle Guevarra 59:01
love I just, I literally just, I have really terrible eyesight in general, and so I find the club

Dr. Gabrielle Lyon 59:09
and zeaxanthin a we’re all in trouble.

Dr. Christle Guevarra 59:13
So, yeah, I don’t know if you have any insight on who designed the graphic.

Dr. Gabrielle Lyon 59:18
So that part, I don’t Okay, but what I can say is that the 10% saturated fat is we need more data. We need more research. Should it be 10% saturated? There’s no evidence that it should be 10. That should be 15. We just don’t have a lot of data. And I think that it is a challenge, because the 10% has been there for so long. So basically, the food, the new food pyramid, the upside the upside down pyramid, keeps saturated fat at 10% what that does, however, is, Well, number one, we don’t have data to change that higher or lower. We had Dr Tom Brown. Not on the show. He wrote the he’s been on the last three guidelines. He wrote the fat part. We’ll have Kevin Mackey. He’s been on the show. He’s coming back again. And these are fat these are fat experts. There needs to be more research. And I will say something else that blew my mind is that the saturated fat recommendation came from a hydrogenated whale blubber during times of war when they needed to feed people. It wasn’t meant to be used. This hydrogenated oil wasn’t meant to be used, but the studies in the 60s grouped this hydrogenated whale blubber and called it saturated fat. Oh gosh, that they were then subsequently saying that that’s bad, but hydrogenated whale blubber isn’t saturated fat. I just wanted to throw that out there that again, this goes back to us believing hearing something no matter how many times we hear it, we believe it’s true, yeah, even though there isn’t evidence for that. Yeah, the

Dr. Christle Guevarra 1:01:08
I don’t have too much of an opinion on the new dietary guidelines. I do like the increase. They’re great guys. I do like the increased protein recommendation. I just for the person’s the patient sitting in front of me. How is that like? That is when I think of like, how is that going to affect the person sitting in front of me? And I can’t really think of too many things that I would change when it comes to how I approach my patients

Dr. Gabrielle Lyon 1:01:38
with these new guidelines. But the good news is, you’ve always been interested in nutrition, yes, but most physicians are not really providing nutrition care, which it seems a bit counterintuitive. You know, especially as primary care, primary care, you are the front line. You are seeing. I mean, listen, I don’t know. I don’t I don’t see kids, but typically Family Medicine, primary care, we see kids. We see all ages, and we’re not trained. Typically, the training doesn’t involve nutritional science training, but if you think about things like elevated levels of triglyceride, yeah, this is a carbohydrate problem, elevated levels of cholesterol. This for some people it’s a fat problem. For some people, it’s a calorie problem, and for some people it’s genetic glucose. There’s all these direct relationships to nutrition, and the training has to increase it a nutrition standpoint, it does the

Dr. Christle Guevarra 1:02:40
and there have been times where protein, like plant based, you know, meaning just eat plants and like, pay no mind to the protein. So I know said nobody ever some people have protein is an important part of this. And so I think that’s why this pendulum kind of swung the other way. With like, we have to put protein in everything. I did you put protein in everything? Protein on our popcorn, protein on this. And that

Dr. Gabrielle Lyon 1:03:04
very misleading, isn’t it?

Dr. Christle Guevarra 1:03:05
Exactly so. And I find that I think that it’s going to shift once again, because I think social media is now tired of protein snacks and everything.

Dr. Gabrielle Lyon 1:03:14
So It’s so disappointing. So we’ve spent 20 years talking about protein. Now people are caring about it, and now it’s getting a bit overblown in the way that protein should be in coffee and popcorn, and it’s ridiculous, and it’s a protein dilution, because it’s not number one, it’s not a threshold amount. Number two, you’re just getting extra calories from protein. Okay, fine, so if that causes the pendulum to swing the other way, it’s we’re going to be constantly doing this back and forth that sets us up for failure. Yeah, I still think it’s the most important macronutrient.

Dr. Christle Guevarra 1:03:52
I do, too. And there are times where people can’t get to, you know, a quality meal. Health care workers, you know, we’re actually, technically not supposed to be eating when we’re at our to be eating when we’re at our desks, but

Dr. Gabrielle Lyon 1:04:04
we, you know, true. Wonder why they kept kicking me out. They didn’t

Dr. Christle Guevarra 1:04:09
when they when they used to do the they used to do the evaluations, like there were times at the hospital where we had to hide our, you know, hide our food because we weren’t allowed to eat at the desk and type our notes at the same time. I want to remember

Dr. Gabrielle Lyon 1:04:21
that, wait, wait, you did your residency. Where’d you do it?

Dr. Christle Guevarra 1:04:25
I did it in the Philadelphia suburbs.

Dr. Gabrielle Lyon 1:04:28
Okay, was that Villanova area?

Dr. Christle Guevarra 1:04:31
No, it was Delaware County, so right outside of Springfield, which is right outside of Philadelphia, and then one of the clinics was in Upper Darby, which is you got to go through West

Dr. Gabrielle Lyon 1:04:44
Philadelphia to get there. Is that unsafe?

Dr. Christle Guevarra 1:04:48
I wouldn’t go walking around there at night.

Dr. Gabrielle Lyon 1:04:51
So she’s got her maze legal there, but I live in Texas, so there’s all kinds of things that are legal here. I. And then your fellowship was in Vegas. Yes, tell me about that sports medicine fellowship that was

Dr. Christle Guevarra 1:05:04
right when covid was happening. So, wow, we had sports. They were just a little truncated, and then all the rest of the sports from Fall were sort of pushed into spring. And so got to work, you know, still managed to have a really good year working with football players, working with all the collegiate athletes, you know, some pro athletes as well. And then I was thinking about, you know, I have all this free time, free time, let me start looking at and looking at EKGs in athletes pre and post covid to see if there was anything significant, because I know that when covid first came out, we were really worried about the effects on the heart and all this other stuff, at least for very healthy athletes, I’d have to go back and look at that paper. But I don’t think we saw anything too, you know, concerning, because you’re already starting with very young, healthy athletes. Covid, you know, it was a very, is a very serious disease. But in that population, it’s like, you’re already at, you know, you’re healthiest, you’re young. And so I, as expected, you know, didn’t really see any too many changes,

Dr. Gabrielle Lyon 1:06:15
which is, I suppose, good, right for the again, this was during the time that people, there was so much that really kicked everything off in a very interesting way that I don’t think anyone has seen in decades and decades, just the division of the country, the division of the world, GLP ones and athletes. Should they and are they allowed to use GLP ones?

Dr. Christle Guevarra 1:06:40
So as of now, I believe GLP ones are on the water monitoring list, so it’s not a banned substance, but they are monitoring athletes who are on these medications to see whether or not there is a performance benefit, whether it can help them, whether it can hurt them.

Dr. Gabrielle Lyon 1:07:00
What about for something like wrestling?

Dr. Christle Guevarra 1:07:05
I mean, you’re thinking about a weight base, yeah. I mean, that would

Dr. Gabrielle Lyon 1:07:09
be totally again, I’m just gonna give you my opinion, yeah, part of that is cheating in the way that I don’t know. Is that true? Is it cheating? I’d have to really think about that statement. My immediate reaction would be like, Okay, so my dad was a collegiate wrestler. He went to Penn. He wrestled. He was captain of the wrestling team. Penny was up for all American total over a tear. Now he’s a mountain man, like, like, sleeps outside. He’s hilarious, but also very smart. He would talk about cutting weight. And so I think maybe the question, and if you guys are out there who are involved in wrestling or any weight based sport, I’d love to hear everyone’s opinion, because is part of a weight based sport, the ability, the discipline, the mental challenge to do. I mean, I don’t know, in my mind, it would be part of it. And I’d

Dr. Christle Guevarra 1:08:02
also have concerns about the weight cut, even of itself. I already have, like, should we even be cutting weight for, you know, sports like wrestling and MMA as a performance enhancing drug in a weight based sport? I would say that it is. It can be very much a performance enhancer. And I wouldn’t be surprised if at a certain point it ends up becoming a performance enhancing drug for certain sports, like wrestling, yeah, so, but I don’t make the rules so, but you should. I’m not on that committee. So the Yeah, I think that we need to be very careful of that for athletes who I don’t have, you know, athletes who are currently on a GLP one that I have come across.

Dr. Gabrielle Lyon 1:08:50
I don’t have any athletes in our practice that are on a GLP one, but hormones is a whole different story. Yeah, and with the conversation of GLP ones, at some point, their anabolic agents are very helpful for muscle, for sarcopenia, for burn, for cachexia, for wasting syndromes. I don’t know what the landscape holds. I know what I hope would happen. You know, as another physician who prescribes medications, do you find it odd that someone could go to their doctor and say, I need a medication that can help me lose weight? But the physician will say, Sure, okay, totally can appreciate that. But if someone goes to their doctor is like, hey, I need a medication that’s helped me build muscle. The stigma is, no, oh, my God, that’s cheating. Cheating for what we’re talking about, maintaining muscle mass. It’s just a very interesting dance, because, from my perspective, optimal health would be. At least 50% of your body weight is muscle. Body fat percentage. Again, some people are leaner than others. Naturally there. There shouldn’t be necessarily restriction. Again, we’re not talking about abuse. We’re not talking about, quote, steroid abuse. We’re talking about, if you are under muscled, it is very difficult. You know, people will say, Listen, I mean, how long have you been trying to get bulky? Oh, me

Unknown 1:10:22
personally, last 40 years?

Dr. Gabrielle Lyon 1:10:24
Yeah, it’s not, you know, from a natural training perspective, it’s very difficult, especially as they age. I mean, yeah, your parents are, what in their 60s or 70s,

Dr. Christle Guevarra 1:10:37
yeah, yeah. And there are, you know, especially with hormone replace, you know, hormone replacement, menopausal hormone therapy, kind of now, like how you

Dr. Gabrielle Lyon 1:10:48
corrected yourself? Yeah, I know it’s like friends, we’re old physician, like they didn’t even, they didn’t even call, we call their hormone replacement therapy, correct, yes. So menopause replacement therapy, okay, they’re just from my perspective, I’ve been seeing patients for a long time, giving them hormones, progesterone, testosterone, they are not You’re not going to really change. I’m curious your perspective. I don’t see a changing body composition. You have to do the nutrition and you have to do the resistance training. Do? Does hormone replacement do a whole bunch of other things? Yes, but does it inherently change someone’s body composition? I haven’t seen it. There may be some mechanisms that don’t necessarily translate to human clinical trials. So the idea that we’re going to be able to really build, maintain, address sarcopenia, we have medications that can help this body fat, yeah, why would we have a stigma against medications that could then be anabolic agents?

Dr. Christle Guevarra 1:11:57
I’m not sure. I also think the landscape is actually changing in terms of how people view I think when you say anabolic agents, people do think, in the 90s, they think steroids are bad and legal, but the things that I’m starting to see now, even amongst physicians, is the peptides, the overall peptide space. And so we went from, you know, steroids are bad to what kind of peptide, like, what kind of peptides are you on? And glps, unfortunately, gets lumped into that, you know, kind of category, but they start listing off all these other agents that, some of them are on the water list for performance enhancing, you know, they’re listed as a performance enhancing drug. And so I feel like this, like, anti anabolic. You know, agents are, I think it’s slowly starting to chip away, because people are starting to be more mindful, or starting to think about, like, what do I want my quality of life to look like? What do I want, you know, 1015, years down the line, like, I don’t want to be sarcopenic, like I want to be strong. I want to do all these things. I’m doing the training, I’m doing the nutrition and but I’m also, you know, in my 50s and my 60s, and I still have a decades left to go. It’s not like it’s 60, you know, like life’s over. What do I want the next couple of decades to look like? And I, you know, they’re starting to ask these questions, and I think the landscape is changing. It’s not very as much like taboo as it once was.

Dr. Gabrielle Lyon 1:13:26
I’m hoping that that continues to be the case. Are you concerned about the lack of randomized, controlled trials for Pep? Have you thought much about the usage of peptides, the efficacy, the evidence of where they are.

Dr. Christle Guevarra 1:13:43
I I have, and I am not an expert on the all of those other, you know, kind of peptides that most people are talking about, particularly for tendon healing for all these other BBC 500 that is a whole nother ballpark that I just haven’t really kind of kept my ear, you know, here and there, see what people are doing. But I’m

Dr. Gabrielle Lyon 1:14:10
not, you’re not using them. No, no.

Dr. Christle Guevarra 1:14:13
Like, please go somewhere else. Like, I’m just not an expert. Like, please, very honorable of you. But, yeah, no, it would be nice to see randomized control trials to see what what is the case, because it sounds like, from what I had heard, that it’s all just rodent data, nothing

Dr. Gabrielle Lyon 1:14:31
for what we’re seeing right now. I have heard that there are, that there is collective human data, but we still have to put it to the tests and the rigors that we would anticipate, which I think are going to start to come out. And then, on the other hand, there is data for anabolic agents that work with various populations. And I do think that we’ve accepted this GLP one use as we. Are not or that we’re going to address body fat, but we also, conversely, have to address skeletal muscle. I personally think that it’s from a health standpoint, even more important, but from a cognitive standpoint. GLP one, if I were to think about, Okay, so what’s the list of priorities? GLP one, use is is an absolute priority for the psychological reasons that you’re talking about, and I think that that is absolutely where the landscape is going. What do you want patients or people to walk away with knowing after hearing our interview?

Dr. Christle Guevarra 1:15:38
One, couple of things. One, if you are having persistent food noise, persistent thoughts about food, especially when you’re dieting, it’s you are not broken. You there are, there are things available at your disposal, tools in your toolbox, that are able to, you know, help with all of that. And asking for help, or even considering having that conversation is not does not mean you’re broken. You are you do not fail at life. You know, we have all sorts of modern technologies that are available to us, YouTube, you know, cars, air conditioning, why can’t Deodorant? Deodorant? Exactly why? You know this. It really just depends on your situation and how you decide to, you know, if you decide to proceed with it, resistance training is always going to be, you know, the most important thing in my book, just because everybody has so many other things that they got to take care of, families, jobs, etc, if I had to pick one thing to do, please pick up something heavy. Challenge yourself and call it a day. Live the rest of your life, three days a week. Three days a week.

Dr. Gabrielle Lyon 1:16:46
Yeah, three sets of 10.

Dr. Christle Guevarra 1:16:48
Yeah, full body, you know, get some get after it. Get after it. And you’ll be surprised at, you know, how much you can get out of that. If this is your first, you know, kind of endeavor in the weight room, and it’s not a scary place. I promise you a lot of bodybuilders, many bodybuilders are really kind and awesome.

Dr. Gabrielle Lyon 1:17:08
Newbie gains, yes, right? The earlier you are to training, the more impactful the the outcome in that condensed window is. So for example, if you’ve been training for, I don’t know, 20 years, you change up your program. Good luck. Yeah, gonna make incremental changes. But if you’re new to training, and especially the women listening,

Dr. Christle Guevarra 1:17:30
yes, the number

Dr. Gabrielle Lyon 1:17:32
one obstacle that I hear from women, and I’m curious as to what your patients say, is, I don’t want to get bulky.

Dr. Christle Guevarra 1:17:40
Yes, that is correct. And I tell them, I start showing them pictures, you know, and saying, like it, you need to really try hard. And other anabolic agents likely are coming into play when you’re absolutely thinking about that.

Dr. Gabrielle Lyon 1:17:55
And how tall are you? You’re my size 411, okay, oh my gosh. I’ve never been on a podcast. I’m taller than you. I am taller than you. This is amazing. I don’t think I’ve ever been taller. This is a first. Well, actually, my sister, I’m taller than Okay, so I’m five one, yeah, and you and I trying to put on muscle. It’s gonna take us. Listen, I’ve been trying to get bulky for, I don’t know, 30 years, not that long, but at least 20. Yeah. So ladies, it’s not, it’s not gonna happen.

Dr. Christle Guevarra 1:18:24
No, it isn’t. And talking about the weight itself, especially when you’re new to resistance training, you the scale might not reflect

Dr. Gabrielle Lyon 1:18:34
good point. Okay, talk to me about that.

Dr. Christle Guevarra 1:18:36
That is another, definitely one of the first things. And I keep having to harp on it, because I find that with a slow, not just the slower rate of fat loss, compared to, you know, whatever it is they were doing before, they get really discouraged. And so I encourage them to take a before picture, take, you know, make note of your clothing size,

Dr. Gabrielle Lyon 1:18:56
and a before picture with clothes on Yes, with

Dr. Christle Guevarra 1:18:59
clothes on Yes, oh my gosh. Clarify that, because there will be times where a lot of times they feel a lot, very discouraged. And I’m like, look at you send me a new picture. Like, great point, and you compare the two. I’m like, did you just like, you know, six months ago, you’ve only lost, like, what, 510, pounds, but the body recomposition, you are down to sizes. Everybody at your work, like, doesn’t believe you when you say you’ve lost five to 10 pounds, because they’re like, No, it’s got to be more you look waste like, way more leaner now. And so those are things that I definitely harp on very early on, and I keep repeating because it’s it’s hard, because you want to see the scale drop

Dr. Gabrielle Lyon 1:19:39
a lot. Basically, what you’re saying is you’re getting ahead of your seeing that the train goes down the track and you’re getting that’s now, friends. This is a very smart physician. That is a very smart physician move is you see what is coming, because you’ve had enough clinical experience, enough reps, to hear what patient struggle. Go with and if they struggle with weight, for example, that they’re actually putting on muscle and losing fat, but the scale is not changing, then they’re gonna be like, I’m done, even if their body looks better. Yes, so you are getting ahead of that that I hadn’t thought about discussing that on this podcast, that is a really good point. Do you like your patients to weigh themselves.

Dr. Christle Guevarra 1:20:22
I do, and I want to do it in such a way that the scale becomes a neutral place and not a place of like, where their emotions run and, you know, where the scale actually determines their worth. So and that takes all been there, and I’ve been there too. Yes, 100%

Dr. Gabrielle Lyon 1:20:37
in there, too. 100% did you gain weight in residency,

Dr. Christle Guevarra 1:20:41
oh my gosh, same oh gosh, yeah, especially during sportsmen fellowship and covid, it was, it was a time it

Dr. Gabrielle Lyon 1:20:50
was ICU baby for me, ICU rotation. Seriously, it was just like, ICU er, not sleeping. I was up at the nurses station eating peanut butter and graham crackers. Graham crackers. Oh yeah, oh yes, even, even remember the applesauce? Gross. That was me. I still eat it peanut butter, peanut butter and jelly sandwiches. Disgusting, yeah. I was like, Oh, disgusting. Terrible idea. Where is it? And so we’ve all experienced that, and I will tell you, that was a period in my life where I just felt so bad about myself. I wasn’t sleeping, I was eating at the nurse’s station. And just not that it’s a bad thing, but it kind of is a bunch of junk food. It is. Let’s just call a spade a spade, it is. It’s a bunch of junk food. Tastes terrible, but stop bringing the Krispy Kreme donuts. But when you’ve been

Dr. Christle Guevarra 1:21:41
up for 24 hours, anything tastes

Dr. Gabrielle Lyon 1:21:43
24 exactly 48 it changes your blood sugar regulation. Oh, yeah, it makes it harder to lose weight. It’s just and again, the scale is a really good thing. So I for context, I’m five $1 No, my normal weight is 110 pounds, give or take. Maybe I’m a little bit lighter, sometimes in residency when I was doing ICU, guess how heavy I was? 125 135

Unknown 1:22:12
No way. Oh, wow.

Dr. Gabrielle Lyon 1:22:13
135 was almost 25 pounds heavier than I am right now. Oh my gosh, I was a size between size four, maybe, like, and again, you guys might be listening to this, like, oh, whatever, yeah, Tiny. And my natural weight is small. And again, it was, I was still training, but it just there is something to be said for being able to track and my diet wasn’t on point. I was exhausted. I was so stressed out. I’m like, you know, you’re looking at X rays and trying to figure out what the zipper line is and what’s this patient’s, you know, ion gap. So we call the resident. There’s codes running. Remember that? Oh yeah, oh yeah, and yeah, I didn’t. I just felt so terrible about my relationship to food at the time, my relationship to weight, and I can only imagine that. You know, thank God that that was a short term experience, yeah, but I’m sure, did that happen to you, too? Oh yeah, when

Dr. Christle Guevarra 1:23:25
I was, when I was a resident, I I made sure to get my protein in, and I made sure to get my lifting in. That was the one thing that, like say, no matter what, no matter what the calories were all over the place, I would eat the crusted donuts that have been sitting there for a day and a half. Like, I just did not care, but I would at least make sure I hit my protein and I went to the gym three to four days a week, and if I was on night float or some other shift like, I would stretch out my like the last week of my training cycle, to a week and a half to two weeks being competitive at that

Dr. Gabrielle Lyon 1:23:59
Time, doing power lifting.

Dr. Christle Guevarra 1:24:00
My last competition was, I was a second year resident, and that, and then I hung my hat, you know, up, and I was like, I’m done with power lifting. I’m gonna switch to body building to give my joints a break. And then also, because I’m, you know, obviously, in a calorie surplus, let’s see how much muscle I can put on. Like, screw it. Like, I’m just gonna, you know, eat.

Dr. Gabrielle Lyon 1:24:21
Was that on purpose, or were you was it a way of coping with the coping the stress that you were like, if I’m gonna put on muscle, so sure, can you do? Oh yeah, no, totally.

Dr. Christle Guevarra 1:24:34
Oh yeah. I just, I realized so at times where I was like, I’m just going to, you know, I’m like, I think 411 and around that time was somewhere between, I think it competed at 72 kilos, like 158 pounds. And so I would fluctuate somewhere between 160 and 170 at 411 and I was snoring, my joints hurt, and I was like, I’m feeling a little beat up. From power lifting, but, but I still want to keep training. I still think that that’s important. Were you thinking

Dr. Gabrielle Lyon 1:25:05
a ton about food at that time, even if you were in, oh, yeah, 100 high calorie during high calorie time, yeah. So this was really, this was not food addiction, but you were, you were just consumed, yeah,

Dr. Christle Guevarra 1:25:19
the the the times where I, like, at 165 170 and 411, like, it was manageable, but I would definitely have to keep snacks on me at like, every two to three hours, just so I wouldn’t turn hangry, you know, in the hospital. But yeah, I decided to switch up my whole training. Just give my joints a break and just increase my reps. Focus on, you know, more bodybuilding style. Because, yeah, I realized that I wasn’t going to get to be lean, and that’s okay. Like, I also realized that residency sucks, and the fact that I’m doing something is better than nothing. So let’s just see how much muscle I can put on or during this time. And then once training, you know, medical training, is over, let’s see where the chips fall and what my life looks like outside of that, and kind of go from there.

Dr. Gabrielle Lyon 1:26:16
Yeah, it’s it’s tough, and just like trying to get through the moments you want all women to lift weights? I do.

Dr. Christle Guevarra 1:26:24
I There’s no, there’s no other way. No, no, there’s no right now we don’t have, you know, Medic, a medication that can just be like, here you go, take this pill and magically grow muscles. And then also, I don’t know if it’s going to help with the tendon issue. So, like, how strengthen your tendons? And, yeah, even if you have all sorts of medical conditions, there are ways around it. Like, there’s plenty of athletes who end up getting ACL surgery, who’s like, Oh, I’m just not going to go to the gym. And I’m like, you did not get you have your other leg and you have a whole upper body. Like, we can, we can work around this. Like, you can get your, you know, turn around and get back into the gym and let’s figure

Dr. Gabrielle Lyon 1:27:04
something made her very unpopular. What is next for you? What are you working on now?

Dr. Christle Guevarra 1:27:11
Just working on a lot more content. I did mention at some point, I think writing a book awesome food, noise, and how that has shaped, kind of my entire life and the decisions I’ve made, and see how that goes. So I’m thinking that’s the, you know, kind of a little bit further down the line, but yes content, and then the book.

Dr. Gabrielle Lyon 1:27:35
Well, Dr crystal, Guevara, did I get it right? Guevara. Guevara, okay, so I’m gonna say it again, because we probably need it for the intro. Okay, well. Dr, Crystal Gruber, no, Guevara, Guevara, guavara. I think guavara. Guevara, yeah. Guevara, yeah, no, I want to get it right. Was it Guevara? Guevara, she’s, well, yeah.

Dr. Christle Guevarra 1:28:02
Good. Lord, I’ll try and marry somebody with a very easy, easily pronounceable last name.

Dr. Gabrielle Lyon 1:28:08
Gosh, okay, ready, ready. Okay, well, dr, Crystal Guevara, which I got your name, last name, right sooner rather than later? The book is needed. Let me know how I can help expedite that. Because I think people hearing it from someone who is a highly trained physician Family Medicine plus sports medicine, who also struggled, and then, you know, I really think you’re normalizing it for people, and that is very valuable, because this way it it kind of breaks that fourth wall. So thank you so much. Thank you so much for having me. I will introduce you to my book agent. Okay, you should not wait. Okay, if you need someone to write it forward, I’ll write it forward for you. Oh, thank you so much. Yeah. Okay, so I made it longer so that we can edit it so crystal, I made it longer than normal because I wanted to have, we’ll do pick ups, but I wanted to have, you know, you guys will decide how much personal content, just also other stuff. So there’s a lot of there’s just a lot of choices, and you’re gonna kill me. I didn’t worry about I’m so sorry.

Unknown 1:29:26
Talk to me about that.

Unknown 1:29:32
Yeah, so we did, so I think it was weight loss, yeah,

Unknown 1:29:37
and then, okay,

Unknown 1:29:40
what’s the diet look like after the diet?

Dr. Gabrielle Lyon 1:29:43
Okay, yeah, so I want her to say that. And then another one. I thought it was this is dead. My thing is dead, died. I have a Sharpie I sent you that didn’t I do you buy? Yeah?

Unknown 1:30:00
It okay, we’re listening. Yeah, another thing you mentioned was supplements. So I was gonna say

Unknown 1:30:06
you have to choose one supplement.

Dr. Gabrielle Lyon 1:30:12
I really like how you’re very particular about how you say stuff I push.

Dr. Christle Guevarra 1:30:18
Since I push the resistance training, I will

Unknown 1:30:21
work another crazy, yeah, there’s a whole lot. This is expose.

Unknown 1:30:33
Okay, I’m listening.

Unknown 1:30:35
Those are the three main ones. We

Dr. Gabrielle Lyon 1:30:42
did a great job.

Unknown 1:30:52
Where are my Sharpies? No idea. And I make up an email intro to the to my book agent, because you shouldn’t wait. You should do it.

Dr. Gabrielle Lyon 1:31:02
This is my unsolicited

Unknown 1:31:06
advice you can take. Yeah, you’ve done a few books already, yeah.

Dr. Gabrielle Lyon 1:31:11
And then also your practice manager, yes.

Unknown 1:31:15
So I’m going to make that intro. I hmm,

Dr. Gabrielle Lyon 1:31:27
yeah, so it would be great. How old is the practice? Oh, gosh,

Dr. Christle Guevarra 1:31:34
2020, November. 2021, and, yeah, it’s been so basically is, is, like, I’ve just been taking a couple of patients. I figured so much YouTube.

Dr. Gabrielle Lyon 1:31:45
Also, I wasn’t promoting it, yeah, also, whatever you tell me, it’s not, you haven’t heard me type anything else. I mean, it’s not. I’m here for it. I’m a very strong female advocate for other women, and I always have been, and that’s part of the reason why I think I’ve done so well, is because I think there’s a level of it’s about what you can give instead of what you get.

Dr. Christle Guevarra 1:32:13
I feel like it’s been really tough to open up and just you’ve also been in

Dr. Gabrielle Lyon 1:32:20
your dynamic has been in a tough day. It’s a tough dynamic. But what I would say is that, yeah, you just, I think you’ve been in a tough dynamic, so it’s not lost. I mean, no can say or not say yeah, it’s I understand

Dr. Christle Guevarra 1:32:35
and yeah, I appreciate it. It’s yeah. I’m glad this is, this is yeah, the first, the first podcast, after degree, after the separation. So I’m just

Unknown 1:32:55
like, right? But you should do, you should do more, you know, like you should do them. It’s the best thing for we need photos. Oh, you want pickups.

Dr. Gabrielle Lyon 1:33:13
You so you saw how I got so much content. Because, like, you’re able to cut some use. Some is better and short, and others, you know, they don’t have to just make a note that they don’t. They don’t have to keep in the order, you know, and where there was areas where we didn’t know, we just cut that out. Like, they don’t have to include where we’re like, oh, this but, oh, we don’t know. Oh, okay. Do you know what I mean? Like, that’s not who gives up? Yeah. He’s so perfect. I All right, Chris, are you ready? Yeah, let’s do it. My friend just had a baby message, Michelle,

Dr. Christle Guevarra 1:34:26
since 2021 I started at 190 Yeah, yeah. I’m still a white belt for many reasons, but I’m experiencing all the weight classes, so hopefully I walk around like, 155

Unknown 1:34:51
Yeah, and the thing was, like,

Unknown 1:34:54
I’ve never. Been down to past 135 never,

Unknown 1:35:04
like, I woke up like 139 so I had to, like, sauna, like eight pounds out. It was just like brutal. Like, brutal, brutal. Oh gosh, food is, I think an Lenin has wrote a book on becoming double checking that um, has wrote a book

Unknown 1:35:28
on becoming double checking. I usually don’t do that. Oh, my coach is like June 132, anyways,

Dr. Gabrielle Lyon 1:35:34
okay, never anything, okay, all right, so let’s start pick up. So what is the pickups?

Unknown 1:35:43
It was the rate of weight loss, yeah.

Unknown 1:35:48
Did you want to chat about that? I was okay.

Unknown 1:35:52
And then what’s the diet look like after the diet? Okay, yeah.

Unknown 1:35:56
She had to choose one supplement. She did pretty know.

Unknown 1:36:09
And so are these just for clips? No, so good, yeah, oh, okay,

Dr. Gabrielle Lyon 1:36:15
so sometimes it’ll be really good things that we explain, why we don’t get to the whole idea. Yeah, need them to do it again. I’m moving around as my fucking hamstring. I’m so fucked up, just like tore that thought it was a good idea to do a 50 hour event when I was finishing my fellowship. So stupid. Is it getting any better? No, it’s been like, 10 years. So it gets so I had tendinopathy on both bilateral tendinopathy. I tore my hamstring, tore my operators, operator in terms, like, and then is there a weird operator of femoris? I’m like, there’s an external, like, but like, some weird where this guy had never seen it before.

Dr. Christle Guevarra 1:37:02
Oh, okay, yeah, geez.

Dr. Gabrielle Lyon 1:37:06
Operator, yeah, from where it’s like crazy, the guy called me. He’s been doing reading it for 25 years. He’s musculoskeletal only, yeah. And he’s like, like, how did you do that? God, wow. Fucking dumb ass kid went running down the street, and I took off sprint day. Fuck myself up. Okay, which is the, what are we doing? So the first one was, basically, I’m just gonna ask you the whatever he

Unknown 1:37:31
says, What’s the rate of weight loss? That what you mentioned, right?

Dr. Gabrielle Lyon 1:37:35
Yeah, yeah. And then is this for your patients, like, what you recommend, your weight of rate loss you recommend for people, okay, wait, don’t tell us more. Nope, yeah, okay, and then we’ll do that next. Okay, okay, okay. For your patients, what is the rate of weight loss that you typically recommend?

Dr. Christle Guevarra 1:37:53
You know, I tend to go a little bit slower, somewhere between a half a percent to 1% of body weight per week, but that’s an average, so I will take their, you know, record their weight, you know, I have them send me at least two weights per week, and then look at the average trend over two to three weeks, versus just, you know, day to day and week to week. And so that seems to be a good average paced. And I tend to kind of go more towards the point 5% body weight per week, on average, for more of my general population patients, depending on where they’re starting at. Do you

Dr. Gabrielle Lyon 1:38:33
and what do you how do you think about the composition of the weight loss?

Dr. Christle Guevarra 1:38:37
You know, I am concerned about that. The issue that I run into is like having them get to a DEXA, or being able to afford a DEXA. So I think looking at the scale, taking a look at clothing fit and size and pictures over time, seems to be good enough with, you know, as a, you know, a cheaper way alternative, but as long as they’re getting their protein in and they’re getting resistance training in, I’m a lot less concerned about like, making sure that I have a DEXA scan on board for their body composition.

Dr. Gabrielle Lyon 1:39:11
Do you guys also use in body or some other type of scale?

Dr. Christle Guevarra 1:39:16
Not at my practice in you know, particular?

Dr. Gabrielle Lyon 1:39:20
Okay, okay, so let’s say someone is and when we say, Okay. RJ, so a point 5% weight, you get your calculator out. So someone is 100 pounds. Okay, so let’s say 100 in you have to calculate it’s 130 pound person. No, you’re not. So although my husband’s so good, I’m like, can’t find his socks. Navigate Afghanistan, no problem. It’s hilarious. So okay, so for 130 pound person, point five, so be a what is it? A. Would you say a point 5% of the body weight? Yeah, okay, so what’s point 5% of 150 pounds?

Dr. Christle Guevarra 1:40:06
6.5 like a half a pound, like, you know, per week. And then you do that over, like, X amount of weeks, you know, usually around, so half a

Unknown 1:40:14
pound a week, yeah, about,

Dr. Christle Guevarra 1:40:17
and then thinking about,

Dr. Gabrielle Lyon 1:40:19
you know, okay, so say that so say a half ago, because the 5% so confusing, yeah, unless we were to calculate that out, because that’s so if a half a so point 5% it can’t be point 5% of body weight, because I’m 6.5 pounds. Right? Is that right

Dr. Christle Guevarra 1:40:39
per week? I’m doing my math wrong. Holy shit. Yeah, somewhere on the or for 150 pound person, I’m thinking about a half a pound to a

Dr. Gabrielle Lyon 1:40:46
pound like, no, even if they’re not like, let’s say someone is 120 pounds. Yes, they’re like, fatty, fatty mcfadson, obviously not paying them on a week. But we still, you still wouldn’t go beyond half a half a pound?

Dr. Christle Guevarra 1:41:03
No, I would not for a small, much smaller person. I agree.

Dr. Gabrielle Lyon 1:41:07
So. Let me ask you this. Can you hear this? These fucking people? Oh, fucking landscapers. I can hear it, but are you able to edit that out? Yeah, once you enhance audio. Okay, so I would, because you don’t want to get a whole bunch of slack, like, What

Dr. Christle Guevarra 1:41:27
do you mean? Oh, good. Oh, good. Oh, we can

Dr. Gabrielle Lyon 1:41:28
read, yeah, we can redo that. Okay, so we do that for your patients, and just in general, what’s a Just kidding okay. All kidding aside for your patients, for you, when you’re thinking about the rate of weight loss, what does that look like?

Dr. Christle Guevarra 1:41:46
Yeah, so if we’re taking a look at, you know, somebody’s 150 pounds, I’m thinking about an average weekly rate of loss, about a half a pound to a pound per week for, you know, on average, 10 to 12 weeks,

Dr. Gabrielle Lyon 1:42:02
and you prioritize the loss of fat, as opposed to, you know, people be like, Okay, it’s about weight loss, but really it’s about the quality loss.

Dr. Christle Guevarra 1:42:11
It’s really about fat loss. I you know, the you want to get rid of, lose the fat and preserve the muscle, for esthetic reasons, for health reasons, all of it. And so you know, as long as you’re getting in resistance training consistently, two to three times a week, and you’re getting your protein intake is adequate, I’m less concerned about making sure that I get something like a DEXA scan or an in body scan, because I find that my patients do have challenges finding a place to go get a DEXA or get an in body scan, and I don’t have one personally that I can give to them.

Dr. Gabrielle Lyon 1:42:49
And you mentioned something before we started recording, and you said, there’s the diet. We talked about higher protein. What is the diet after the diet is done,

Dr. Christle Guevarra 1:42:59
it looks very similar to the diet, but the calories are purposely increased, and so that you can allow, you know, allow for recovery and and shifting your mindset from always having to lose and thinking more of, you know, maintaining that, you know, average scale weight. And so it’s going to increase because you’re increasing your food volume, you’re increasing your calories. So making sure that your patients are well aware of the scale is going to go up a little bit. And over the next couple of weeks, it’s going to take a while to settle but you are going to find that the weight, your maintenance weight, should kind of hover around a nice range compared to when you ended your fat loss, kind of diet.

Dr. Gabrielle Lyon 1:43:47
I like that. It’s really the days of Crash dieting, the days of these very complicated diets are over, really. We can simplify it. We can bring back my plate, my special place, with has, you know, again, how we do it in the book is 1/3 protein, 1/3 fruits and vegetables, and then 1/3 starchy carbs. Yeah, easy, yeah. And just

Dr. Christle Guevarra 1:44:10
more of it, more of the same, awesome things.

Dr. Gabrielle Lyon 1:44:13
I love it. So if you’re eating Cheetos and rip its that’s not what we’re talking about. You are eating high quality protein, lean foods, fibers, fruits and vegetables, if you’re training, obviously, yeah, potato, rice, whatever. All right, I’m here for you.

Unknown 1:44:32
And the last one was, if you had to choose one supplement, okay,

Dr. Gabrielle Lyon 1:44:40
all right, if you had to choose one supplement, what

Dr. Christle Guevarra 1:44:43
would it be? I would have to say creatine, because one it, we have the most data on it as far as safety goes, and so I feel like out of all of them, that would be the best. And also all of my patients are resistance training, and so that’s going to help support muscle. People and support performance. And people seem to, you know, once they start getting into the gym, that is kind of the most common question I get. Like, what do you think about creatine? I’m like, Well, let me tell you,

Dr. Gabrielle Lyon 1:45:12
we’ve got 60 years of data. Gosh, the I will say one of the things that we so, we use creatine networks all time. We also use essential amino acids, especially if people are reducing their total food volume for muscle recovery, it seems to be extremely helpful. We use perfect amino they got a great mocha flavor, great vanilla flavor. I mean, just get it done. Then the whole point is, how do we make a nutrition plan that is not over complicated, and you’re not thinking about a bunch of things, correct, right? It’s not a whole bunch of ancillary products. It’s, you know, for us, it’s omega three fatty acids. I believe that people need vitamin D. You can test for that, creatine, essential aminos, pretty much, you know, those are the go to. We will use urolithin, a have you used that? There’s really good human data for improving mitochondrial function, and the mechanism is, actually, I will tell you this, it has been shown in humans to improve strength and endurance, because it improves the health and the mitophagy, which is kind of cool, and that’s it simple, yeah, good, yay. So let’s see some photos. I’ll start with you.

Unknown 1:46:42
First, I

Unknown 1:46:45
get you right here in the center. Okay, this way. Perfect, okay,

Unknown 1:46:58
okay, all right. Was good, good. Thank you. Have you been boxing, four, competitively, like, three years.

Unknown 1:47:11
Should we do join a video that we’ll send to the team? Yeah? Okay, all

Dr. Gabrielle Lyon 1:47:18
right, guys, I just never happened before. I’ve never done a podcast on taller than someone I am wearing heels, but you are before 11, 951, although my friends make fun of me. Anyway. Dr, Crystal, Rivera is in studio today, and when we talk about crystal, oh gosh.

Dr. Christle Guevarra 1:47:34
GLP, ones navigating resistance training life, all the

Dr. Gabrielle Lyon 1:47:38
noise getting jacked, we’re both tracking no Doom record. Just kidding. Let’s Can you take a picture of us? Yes, I guess you can keep this one for when we put the episode out. Oh, God